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Human Development and Family Sciences
Oregon State University
INTERNSHIP PROGRAM LEARNING AGREEMENT
(Please print clearly)
STUDENT & COURSE INFORMATION:
Intern Name:
Student ID #:
ONID Email:
Phone #:
Mailing Address:
Academic Term/Year of Internship:
HDFS Options (circle all that apply):
Human Services
Child Development
(circle one)
HDFS 209
HDFS 410
(Requires 90 field hrs.)
(Requires 270 field hrs.)
Gerontology Certificate
General
SITE & SITE SUPERVISOR:
Agency Name:
Site Supervisor:
Email:
Site Supervisor Phone #:
Mailing Address:
Deadlines to submit this document:
Term I plan to serve my
Deadline for *Off-List Sites
Deadline for *On-List Sites
internship:
Winter
Friday 5pm of WK6, prior Fall term Friday 5pm of WK8, prior Fall term
Spring
Friday 5pm of WK6, prior Winter
Friday 5pm of WK8, prior Winter
term
term
Summer
Friday 5pm of WK6, prior Spring
Friday 5pm of WK8, prior Spring
term
term
Fall
Friday 5pm of WK6, prior Spring
Friday 5pm of WK8, prior Spring
term!!
term!!
*Off-list and on-list refers to sites not-included or included, respectively, on the Approved HDFS Internships
List, available here:
http://health.oregonstate.edu/students/current/undergraduate/internships/hdfs#internship-sites
>>TURN THIS IN BY THE ABOVE DEADLINE TO THE LOCKBOX OUTSIDE Waldo 401<<
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Intern Goals and Job Description
What 3 goals do you want to accomplish during your internship experience? Consider knowledge, skills, and
personal development goals. Be as specific as possible. (Please share with your site supervisor)
1.
2.
3.
What sorts of tasks might you participate in, in order to reach your goals? Are there any trainings, readings,
or other events or strategies that will help you achieve your goals? (Consult with your site supervisor about
possibilities)
Intern Job Description: (Attach separate sheet if necessary.)
Termination
If at any time during the internship the Intern does not fulfill her/his professional obligations to the
agency/firm/school, the Intern will be terminated from the internship. The decision for this termination
shall be made by mutual agreement between the Site Supervisor and the Internship Program Coordinator.
If it becomes impossible for the agency/firm/school to adequately assist the Intern to meet her/his goals,
the Intern will have the option to terminate the internship experience. The decision for this termination
shall be made by mutual agreement between the Intern and the Internship Program Coordinator.
Intern Initials
Site Supervisor Initials ______
----------------------------------------------------------------------------------------------------------------------------------------------HDFS Internship Instructor: Julie Graves, Ph.D.
[email protected]
541-737-2451
Last Updated 5/15/15
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ROLES & RESPONSIBILITIES
Intern Responsibilities:
1. I agree to work at least the total number of hours indicated above in accordance with OSU/HDFS
requirements.
2. In the event of illness, I will notify my Site Supervisor immediately.
3. I will follow all pertinent policies and regulations of the agency/firm/school.
4. I will provide all personal expenses connected with the internship, including transportation to and from
the place of work, housing, and other personal/professional needs.
5. I will keep the Internship Program Coordinator informed of my progress, including problems that I
encounter, changes in my internship responsibilities, and any other relevant matters.
6. I will keep my Site Supervisor informed of my progress on assigned responsibilities.
7. I will conduct myself in a professional manner.
8. I will abide by the ethical standards specified by my internship site and as outlined in the human
services code of ethics.
9. I will accept responsibility for providing my own liability, health, and accident insurance.
10. I will participate in the seminar component of the internship experience.
11. I will complete all assignments given to me by the Internship Instructor, including weekly meetings
with site supervisor
To Pass the Internship Course, Interns Must:
1. Pass the corresponding HDFS course (209/410) in accordance with established syllabus.
2. Attend all seminars and participate fully in class activities. Or, with permission, complete an online version of the course (for interns living prohibitively far from OSU to attend class).
3. Complete all tasks assigned by Site Supervisor and all hours specified in this contract.
4. Obtain a midterm and final evaluation from her/his Site Supervisor
Site Supervisor Responsibilities:
1. I will orient the intern to the agency/firm/school, including any training normally given to new
employees at the professional level.
2. I will provide opportunities for the fulfillment of the Intern’s goals.
3. When necessary, I will work in cooperation with the Intern and the Program Coordinator to revise
Intern goals.
4. I will provide individual guidance and supervise the Intern’s work during the field placement.
5. I will schedule a midterm conference to discuss the Intern’s work performance and analyze strengths
and problems.
6. I will facilitate, whenever feasible, the Intern’s participation in staff/employee activities of a
professional nature.
7. I will confer with the Internship Program Coordinator on any problems or ways in which the Internship
Program Coordinator may assist me with the achievement of the Intern’s goals.
8. I will complete a written evaluation of the Intern at the middle and end of the term.
9. I will meet with the intern to discuss weekly assignments, with the understanding that it is the intern’s
responsibility to initiate these meetings.
----------------------------------------------------------------------------------------------------------------------------------------------HDFS Internship Instructor: Julie Graves, Ph.D.
[email protected]
541-737-2451
Last Updated 5/15/15
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Internship Instructor Responsibilities:
1. I will serve as liaison and resource person for the Intern and Site Supervisor to facilitate Intern goals.
2. I will supervise the intern via contact with both the Intern and the Site Supervisor.
3. When necessary, I will help to resolve problems between the Intern and her/his Site Supervisor and
terminate relationships that are not working.
4. I will provide leadership for the seminar component of the internship experience.
5. I will evaluate the Intern’s written assignments.
6. I will assess the intern’s midterm and final evaluation, completed by Site Supervisors.
7. I will assign a grade upon completion of the internship and seminar experiences.
IMPORTANT changes to OSU’s HDFS Internship Program:
Background Checks: According to OSU policy, we are unable to perform background checks on OSU students,
nor are we able to offer any assurances regarding a student’s background. As such, internship sites requiring a
background check must conduct their own or require the student to obtain the background check
independently.
Restricted States: Internship sites in the state of Maryland, Massachusetts, Minnesota, New Hampshire, New
Mexico, or Tennessee are no longer approved as HDFS internships due to legal incongruences.
The student, the Site Supervisor and the Internship Instructor agree to fulfill their responsibilities as outlined
in this learning agreement:
Student Intern Signature
Date
Site Supervisor Signature
Date
________________________________________________________________________________
Internship Instructor Signature
Date
----------------------------------------------------------------------------------------------------------------------------------------------HDFS Internship Instructor: Julie Graves, Ph.D.
[email protected]
541-737-2451
Last Updated 5/15/15